What are the most common bisphosphonates (Bone Phosphonates)?

From the Guidelines

The most common bisphosphonates used in clinical practice are alendronate, risedronate, ibandronate, and zoledronic acid. These medications are approved by the FDA for postmenopausal osteoporosis and work by inhibiting osteoclast-mediated bone resorption, thereby increasing bone mineral density and reducing fracture risk 1.

Key Points

• Alendronate is typically prescribed as a 70mg tablet taken once weekly, while risedronate is commonly given as a 35mg tablet weekly or 150mg monthly 1.
• Ibandronate comes as a 150mg tablet taken monthly or as a 3mg intravenous injection every three months 1.
• Zoledronic acid is administered as a 5mg intravenous infusion once yearly for osteoporosis or more frequently at different doses for cancer-related indications 1.
• High-quality evidence from a 2017 study showed that bisphosphonates, including alendronate, risedronate, and zoledronic acid, reduce vertebral, nonvertebral, and hip fractures compared with placebo in postmenopausal osteoporotic women 1.

Important Considerations

• When taking oral bisphosphonates, patients must remain upright for 30-60 minutes after administration and take them with a full glass of water on an empty stomach to maximize absorption and minimize esophageal irritation 1.
• Common side effects include gastrointestinal disturbances for oral formulations and flu-like symptoms for intravenous preparations 1.
• Rare but serious adverse effects include osteonecrosis of the jaw and atypical femur fractures, particularly with long-term use beyond 3-5 years 1.

From the FDA Drug Label

Alendronate sodium is a bisphosphonate that acts as a specific inhibitor of osteoclast-mediated bone resorption. Bisphosphonates are synthetic analogs of pyrophosphate that bind to the hydroxyapatite found in bone. Atypical subtrochanteric and diaphyseal femoral fractures have been reported with bisphosphonate therapy, including zoledronic acid injection

The most common bisphosphonates are not explicitly listed in the provided drug labels. However, based on the information provided, two examples of bisphosphonates are:

• Alendronate sodium
• Zoledronic acid 2 3

From the Research

Common Bisphosphonates

The most common bisphosphonates used in the treatment of postmenopausal osteoporosis and other bone-related diseases include:

• Alendronate
• Risedronate
• Ibandronate
• Zoledronic acid
• Clodronate
• Pamidronate

Bisphosphonates for Postmenopausal Osteoporosis

Bisphosphonates that have been shown to reduce the risk of osteoporotic fractures in postmenopausal women are:

• Alendronate 4, 5, 6
• Risedronate 4, 5, 6
• Ibandronate 4, 7, 5, 6
• Zoledronic acid 7, 5, 6

Administration and Efficacy

These bisphosphonates can be administered orally or intravenously, with varying efficacy and safety profiles:

• Alendronate and risedronate are oral agents 4, 5
• Ibandronate is available in oral and intravenous formulations 7, 5
• Zoledronic acid is an intravenous drug 7, 5
• Clodronate and pamidronate are also used in the treatment of metastatic bone disease 7